HomeMy WebLinkAbout163967 09/17/2008 F CITY OF CARMEL, INDIANA VENDOR: 361873 Page 1 of 1
0 t ONE CIVIC SQUARE JEFFREY STRAUB
CARMEL, INDIANA 46032 5028 ST CHARLES PL CHECK AMOUNT: $408.92
ar Vi a. CARMEL IN 46033 CHECK NUMBER: 163967
CHECK DATE: 9/17/2008
DEPARTMENT ACCOUNT PO NUMBE INVOI NUM BER A MOUNT DESCRIPTIO
1047 4343000 408.92 TRAVEL FEES EXPENSE
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Team :Registration Form
j 2008 Ellis Associates International Lifeguard Challenge
Agency Caymd (k� ain Contact i n
Address l
Phone r I; E -mail Address1{
CAI`
Team Members
1� Team:
Name Shirt Size
2.
3,
n i
4.
i
Judge (ideall an instructor) Guests in Distress /Additional People
Name I Shirt Size Name
Shirt Size
1. A 1. 0�rA xT' X L
2.
3 e,v
e��'1 �Q�d►'1Z2 4. o
Fees
Quantity: Total
Competitive Team $150 /team
U Judges $25/ person 1
v Guest in $25 /person
Distress /Additional
People
Total Enclosed
This registration form and the liability release (filled out by every person attending)
forms must be received by the host site (whether mailed or faxed) at least ten 00) days DD
prior to your event in order to receive a T- shirt. Registrations will be accepted up to five
days prior, however you will not receive shirts. Checks should be made payable to the
host facility. Call to confirm receipt of your materials?
QFFTCI C1E'O.NL:Y Total Fee Received Check Number
Date Received Liability forms rec.
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Renaud Spirit Center
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Your Recreation Destination DATE: AUGUST 25, 2O08
200Tri Sport Circle
n'Fa\km, MO 63368
06'474'2RE[
TO Tina nntze
Aquatics Manager RECEIVED
12}5 Central Park Dr. East
Carmel, IN 46032
P: 317.573.5250
F: 317,573,5254
/»o�e@ca,n*�(avpa,ka.cum
SALESPERSON JOB PAYMENT TERMS
DUE DATE
Due on receipt
QTY DESCRIPTION UNIT PRICE LINE TOTAL
Competitive Team
Judge
7 Guest In Distress /Additional People
Description W
SUBTOTAL $350
SALES TAX NA
TOTAL $350
Make all checks payable to City o(O'FaUon
THANK YOU FOR YOUR BUSINESS!
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PRESCRIBED BY STATE BOARD OF ACCOUNTS t GENERAL FORM NO. 101 (1986)
EAGE CLAIM
To P
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
COPPICE. BOARD, DEPARTMENT OB 1NSTUUTION1
DA FROM TO I SPEEDOMETER AUTO T
READING m n
z NATURE OF BUSINESS MILES �,5 s
ppINT POINT START FINISH TRAVELED PER MILE
4 '1 1 i IC 1
E
1
i
AUTO LICENSE NO. TOTALS
SPEEDOMETER READING columns are to be used only when distance between paints cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing all just credits
end that no part of the same has been paid.�� P
Date
Ck
l' �p
J
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Straub, Jeff Terms
5028 St Charles Place Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8112/08 Reimb. mileage 7123108 408.92
Total Is 408.92
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20_
Clerk- Treasurer
a
Voucher N -0. Warrant No.
i
Straub, Jeff Allowed 20
5028 St Charles Place R.
Carmel, IN 46033 MAIL-
C1 -CV, In Sum of
408.92
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 Reimb. 4343000 408.92 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
18 -Aug 2008
Signature
408.92 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund